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A 42-year-old woman presented with a 3-month history of transient episodes of syncope. These sudden episodes occurred without warning and were associated with loss of consciousness, palpitations, epigastric discomfort and a fixed upward gaze of both eyes.

Her symptoms had progressed with increasing frequency to 2–3 times a day and each episode persisted for more than 20 min. The patient had no significant medical or family history.

Her physical examination was unremarkable and no arrhythmias were noted on ECG. Blood tests and head CT images were unremarkable.

A bedside transthoracic echocardiogram was performed, which showed in subcostal view, an elliptical shaped mobile mass located in the right atrium, measuring about 6 cm×5 cm in size, prolapsing through the tricuspid valve into the right ventricle during diastole (figure 1A,B). The right atrium, right ventricle and inferior vena cava were enlarged.

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